VCU researcher targets spatial neglect when your brain sees only half the world

By Kyra Newman

Timothy Rich starts with a simple statement: "Imagine ignoring half your world without realizing it."

As in, shaving only half your face. Failing to notice food on one side of your plate. Reading text starting from the middle of the page.

For many people recovering from stroke or traumatic brain injury, this is daily life. And for Rich, Ph.D., this complex, often hidden cognitive condition - spatial neglect - has framed his research career, which he is continuing as a new assistant professor in Virginia Commonwealth University's Department of Occupational Therapy, part of the College of Health Professions.

In exploring the puzzling and profoundly disabling condition, Rich is blending clinical insight, emerging technology and a deep curiosity about how the brain pays attention. His scientific path has taken him from inpatient rehabilitation hospitals to a nationally funded research program - and now to Richmond.

Rich came to VCU from Kessler Foundation, one of the nation's leading rehabilitation research centers. The move, he said, was driven by his desire for a place where his work and research funding could grow.

At Kessler, most of his collaboration occurred within his immediate lab, and "I missed being around occupational therapists - my people," the registered/licensed OT said with a laugh. "I wanted to be part of an OT department again, to share ideas across allied health disciplines and to grow the department's research in the area of adult neurorehabilitation. VCU felt like the right fit from the moment I met the faculty."

The mystery of spatial neglect

Rich's primary research population includes adults recovering from stroke, TBI, multiple sclerosis and, eventually, Parkinson's disease and other degenerative neurologic disorders. But his central scientific question remains focused on helping people who don't understand they're missing one side of their world.

Spatial neglect occurs when the brain fails to attend to the side of space opposite a neurological injury. A person with a right-hemisphere stroke, for example, might unintentionally ignore the left side of their body or environment.

"It's not a vision problem," Rich said. "It's a cognitive-attentional problem. The visual system works. The brain just isn't interpreting the information."

The consequences can be startling, such as walking into doorframes. And because traditional paper-and-pencil assessments are easy to compensate for, clinicians can miss the condition entirely.

"It's one of the biggest barriers to independent living following stroke," Rich said. "Someone might regain strength or mobility, but if they can't safely perceive their environment, they still can't function independently."

Seeing what the eyes - and head - reveal

Rich's current National Institutes of Health grant focuses on the specific manifestation of left-sided neglect dyslexia, a reading impairment in which people omit or distort the beginnings (i.e., left side) of words or lines of text. To study this, he uses innovative eye-tracking glasses that allow participants to move naturally, rather than sitting with their heads fixed on a chinrest.

Historically, researchers could only measure eye gaze when a participant's head was immobilized. Those limitations made the data precise but not realistic.

"With new wearable technology," Rich said, "we can finally see how the eyes and head work together in everyday reading. Nobody has really looked at head movements in this population before, but they may be a major compensatory tool."

To start, he aims to improve assessment by developing more precise, technology-enhanced tools that can detect subtle changes in spatial attention. In return, Rich's work can build the foundation for better treatment, using what he learns about natural gaze patterns to create interventions that support safe, functional behavior.

"While traditional assessment methods often miss patients with milder spatial neglect and are vulnerable to testing effects, the use of biometrics such as eye tracking may be the most sensitive method to identify spatial neglect and may provide a more precise method for monitoring change over time," Rich said. "You can't fake where your eyes are looking."

Assistive technology meets OT

Before stepping fully into research, Rich spent years in inpatient rehabilitation, where he became known for creative, affordable assistive devices - especially for patients with high-level spinal cord injuries. He remembers those early years as pivotal.

For patients without or with limited upper limb movement, "being able to use their smartphone or computer changes everything," Rich said. "It restores a sense of autonomy. And seeing that sparked my interest in how technology can level the playing field for people with disabilities."

That early work led him to explore eye tracking as an alternative method for his patients to access technology. Later, Rich realized its value as a research tool - a connection that shapes his current scientific trajectory.

Now at VCU, Rich is forming a new mentorship team and preparing for teaching assignments, including supervising students on their capstone projects. He also is eager to collaborate across the College of Health Professions and health sciences campus on initiatives connected to neurologic disorders.

"I want my research to eventually support better clinical decision-making," Rich said. "If we can measure spatial neglect more precisely, we can identify patients experiencing it more consistently, determine the efficacy of experimental treatments more effectively and, ultimately, empower patients to live safer, more independent lives."

This story was originally published on the College of Health Professions website.